The Rendu-Osler-Weber Disease Revealed by a Refractory Hypoxemia and Severe Cerebral Fat Embolism
Pulmonary arteriovenous fistulae associated with the Rendu-Osler-Weber disease. The contrast study performed during a transesophageal echocardiographic examination depicted a massive opacification of the left atrium a few beats after the opacification of the right atrium through the left and right pulmonary veins (a), but no patent foramen ovale, and a subsequent massive opacification of the aortic arch (b). Pulmonary angiography confirmed the presence of multiple arteriovenous fistulae in the two lungs ((c) and (d), arrows), the largest being located in the left inferior lobe (thick arrow). These lesions were subsequently excluded from the pulmonary circulation by serial percutaneous transcatheter embolizations. LA: left atrium; La: left atrial appendage; PV: pulmonary vein; Ao: aortic arch.
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